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The parotid glands are large salivary glands located just in front of your ears and extending into the upper portions of your neck. Tumors of the salivary glands are not very common, but they do account for about 6% of tumors in the head and neck. Interestingly, the likelihood of a salivary gland tumor being malignant increases as the size of the affected gland decreases.
Usually, parotid tumors are first noticed as a painless lump in the cheek or upper neck, and may slowly grow over time. Benign parotid tumors are more common in women, while cancers occur equally in men and women.
A history of radiation exposure can increase the risk of both benign and malignant parotid tumors. A history of smoking, in contrast to other organ systems, does not seem to be linked to salivary gland cancer, but it does increase the risk of a certain benign parotid gland tumor, call Warthin’s tumor. Initially, a needle biopsy may be performed in the office in an effort to diagnose the type of tumor. Surgery is performed through an incision that runs in the crease in front of the ear, down onto the upper neck. Nasal obstruction can be quite bothersome and have a detrimental effect on one’s quality of life, contributing to everything from chronic mouth-breathing, to snoring, to even decreased exercise stamina. The nasal turbinates are structures that are attached to the outer walls of the inside of the nose.
The middle nasal turbinates (as opposed to the lower, or inferior, turbinates) are normally thin and non-obstructive.
Polyps are mass-like swollen areas of mucosa (nasal lining) that usually form in response to chronic inflammation of the sinuses. The external and internal nasal valves describe areas near the front of your nose that are normally relatively narrow points in the nasal passage. Although medications can affect obstruction due to swollen nasal turbinates, and to some extent polyps, the other causes of nasal obstruction listed above typically require some type of surgery for a permanent solution. If you have chronic bothersome nasal obstruction, schedule an appointment to figure out the cause and explore treatment options.
Laryngopharyngeal reflux (LPR) is a condition in which there is reflux of gastric contents (acid, digestive enzymes) into the upper throat. The symptoms are nonspecific, meaning there are other conditions that can cause the same symptoms. My practice is to perform flexible fiberoptic laryngoscopy on patients with the above symptoms. In many cases, especially if there is associated problems swallowing, I will recommend a barium esophagram. Tinnitus, which affects nearly 50 million Americans, refers to the perception of an extra sound that is not generated by anything external to the body. Some potentially serious causes of tinnitus exist, and your doctor may recommend specific testing if one of these causes is suspected. What you have just experienced is known as Sudden Sensorineural Hearing Loss (SSNHL), a distressing condition that affects somewhere around 10-20 per 100,000 people each year.
The numbers vary depending on the study, but about 50% of people get at least some of their hearing back spontaneously (without treatment). Second line: if hearing was not recovered after the above treatment, OR for patients who cannot take oral steroids, I use transtympanic steroids.
The external ear and ear canal – funnels sound from the external environment down to the eardrum.
The middle ear – uses mechanical advantage to transmit and amplify sound (about 25 dB of gain).
Your voice is one of your greatest assets, and is something most of us depend on day in and day out. Most tubes are designed to stay in place for 8-12 months, and the vast majority fall out on their own sometime around this timeframe. These are updated guidelines just released by our national academy that give specific recommendations about when tubes are and are not recommended. If there is fluid in both ears longer than 3 months and the hearing test shows a hearing loss, then tubes SHOULD be considered. If there is fluid in one or both ears longer than 3 months and it is causing symptoms (balance problems, poor school performance, behavioral problems, ear discomfort), then tubes SHOULD be considered. If tubes are not placed, every patient with fluid in their ears should be checked every 3-6 months until: (1) Fluid resolves, (2) Hearing loss detected, (3) Structural problems with eardrum start to develop. Recurrent ear infections: either 4 infections in the past year (with 1 or more being in the last 6 months), or 3 infections in the past 6 months. Keep in mind that these are only guidelines, and particular aspects of your child’s case may prompt a different recommendation. The decision to purchase hearing aids can be daunting, especially when considering the wide variety of designs and features available, as well as the cost. The parotids are the largest of the major salivary glands, which also include the submandibular glands (under the law bone on each side) and sublingual glands (under the tongue).
A parotid gland tumor has about a 20% chance of being malignant, while this increases to 50% for the submandibular gland and much higher still for the sublingual and minor salivary glands.
If the tumor is painful or grows quickly, these are more worrisome signs that it could be cancerous.
Certain cell types comprise small units of the gland called acini that actually produce the substances in saliva, while other cells make up different types of ducts that drain the saliva from the gland. Needle biopsies are not perfect, but they are often useful in directing further treatment planning. Although some benign tumors can be observed, most of them will continue to grow over time and can eventually cause both functional and cosmetic impairments. The main risk of surgery is injury (temporary or permanent) to the facial nerve, which is responsible for movement in that side of the face. Several structural problems can contribute to the sensation of blocked nasal passages and trouble breathing through the nose.
Even in small amounts, this can cause significant irritation and damage to the voice box and upper throat.


These can include chronic sinus infections, allergies, throat dryness, and growths in the throat (both benign and cancerous). This is a quick office procedure involving a small flexible scope that is inserted through the nose to visualize the throat and vocal cords. Typically this requires treatment with an acid-suppressing medication like omeprazole (Prilosec).
The following foods can worsen acid reflux and should be reduced: very fatty foods, spicy foods, carbonated beverages, acidic juices, caffeine, alcohol, and tobacco. This will help keep your vocal cords and throat from drying out, which only compounds the irritation. Certain areas, such as the front portion of your nasal septum (the wall that divides the inside of your nose in half) are especially rich in blood vessels. Leaning your head back will only encourage the blood to go down your throat, which can make you nauseated! Drink plenty of water, at least 8-10 cups per day (unless of course you have a medical condition that requires fluid restriction).
The vast majority of tinnitus cases, however, are thought to be related to some degree of damage to the delicate hair cells within the inner ear, which are responsible for hearing.
Many patients are bothered the most by tinnitus when they are in quiet environments, such as trying to fall asleep. These resemble hearing aids and can be programmed to provide a low-level masking noise, which can reduce or eliminate tinnitus.
This usually involves some type of hearing aid, unless the hearing loss is a type that can benefit from surgery. This involves wearing a noise-generating device that, over time, trains your brain to ignore the tinnitus as a normal, non-bothersome sound. This involves using various relaxation techniques to change one’s reaction to tinnitus, thus training yourself to stop thinking of tinnitus as bothersome. You suddenly hear a funny popping or cracking sound in your left ear and feel like your ear is plugged up, like you need to pop it. The delicate blood supply to the inner ear has no built-in redundancy, as other ares of the body do.
This allows mixing of fluids with different electrolytes that normally should not mix, causing damage to the delicate structures that sense sound. An acoustic neuroma (benign tumor of the balance nerve than can press on the hearing nerve) can cause gradual OR sudden drops in hearing.
Generally, the only thing that shows the most consistent benefit is steroids (prednisone, etc).
Full dose (60 mg) per day for 9 days, then taper the dose over the next 5 days, for a total of 2 weeks of treatment.
This involves injection of a steroid (dexamethasone) through the eardrum into the middle ear space, where it can be absorbed into the inner ear. Depending on the size and location, this can cause anything from a slight to a moderate hearing loss. Injury to, erosion of, or stiffening of one or more of the three hearing bones can cause significant conductive hearing loss. Once in the brain, the impulses spread out along multiple complex pathways to the cerebral cortex, where we are able, finally, to perceive and interpret the sound. This can be due to the aging process, genetic predisposition, toxins, infections such as viruses, or exposure to lots of loud noises.
If you think you may have a hearing loss, the first step is to schedule an appointment for a hearing test. This may seem like common sense, but often you don’t realize you are overdoing it until there is a problem. Being in a dry climate like Colorado is a definite setback when it comes to taking care of your voice. A natural tendency when there is throat irritation from mucous, dryness, or acid reflux is to clear the throat. You may not have classic symptoms of heartburn, yet you may still have a condition known as Laryngopharyngeal Reflux, which is acid reflux that irritates your upper throat and vocal cords.
When fluid lasts longer than 3 months, the chances of it going away on its own within the next year drop dramatically.
If either of these applies, AND there is fluid in the ear(s) when the ENT evaluates the child, then tubes SHOULD be considered.
For example, we tend to offer ear tubes more liberally in at-risk children, such as those with a pre-existing hearing loss, developmental problem or speech delay, blindness, or cleft lip and palate. It is very important to have an audiologist who will work with you to hone down on the most appropriate option for you. You also have nearly 1000 minor salivary glands, which line the inside of the mouth and throat. A leading theory suggests different kinds of benign and malignant salivary tumors arise from the different types of stem cells that exist inside the gland. Great care is taken during surgery to protect the nerve and its many branches, so that the risk of injury can be minimized. The septum can be deviated (or bent) into one or both sides of your nose, causing obstruction.
Turbinate tissue swells in response to many factors, including allergies, infections, inhaled irritants, and hormonal changes.
This causes the turbinate to be much larger than normal and can contribute to nasal obstruction.
Weak or abnormally positioned cartilage composing the outer wall of the nose can cause static (there all the time) or dynamic (occuring when you breathe in) collapse of the nasal valve. Also, even specialized testing with pH probes designed to detect episodes of acid reflux are not 100% accurate.
The purpose of this procedure is to 1) look for other causes of the symptoms and make sure there is not a tumor present, and 2) look for characteristic findings of acid damage to the throat and vocal cords.
Often it is recommended to take this twice per day, as opposed to once a day (the standard treatment for typical GERD).
Instead, when you feel the urge to clear your throat, swallow instead or take a sip of water.


It can affect one or both ears, or simply be perceived as a “head noise” without a clear direction or origin. This damage can occur as a result of the normal aging process, exposure to loud noise, exposure to toxins or certain medications, and other less common disorders. In many cases, treatment of these associated conditions can improve both the symptoms of tinnitus as well as one’s ability to cope with tinnitus. One tiny blood clot or spasm (temporary closing off) that blocks the blood vessel can cause significant, possibly permanent hearing loss.
The first phase (#1 and #2 in the picture) consists of the mechanical transmission of sound from the external environment all the way to the inner ear. It transfers sound energy from an air medium (the external environment) to a fluid medium (the inner ear is full of fluid). If the hearing loss is so severe that hearing aids no longer work, you may be a candidate for a cochlear implant, which is a device that converts sound to electrical energy and stimulates the hearing nerve fibers directly, thus bypassing the nonfunctional or absent hair cells. Even mild dehydration will cause your throat and larynx to become dry, with thicker, more irritating mucous. If you’re not careful, this can become habitual, leading to a vicious cycle of irritation, throat clearing, which leads to more irritation, and so on. In children, it requires a very brief general anesthetic delivered by mask (no intubation, and usually no IV). If there are recurring ear infections but there is NO fluid in the ears when the ENT evaluates the child, then tubes SHOULD NOT be placed. The most common tumor of the parotid gland, a pleomorphic adenoma, has a small risk of becoming a cancer. Disruption of the normal laminar (straight-line, smooth) flow of air in your nose causes areas of turbulence that cause the sensation of blockage as well as significant dryness of your nasal lining. For this reason, many patients with this condition do not have the classic symptoms of gastroesophageal reflux (GERD), such as heartburn and indigestion.
Treatment is usually continued for 3-4 months to minimize the chance of recurrence of symptoms. When the thin surface of the nasal lining is disrupted, such as with minor trauma or nose picking, one of these blood vessels can open up and a brisk nosebleed can result.
It may be continuous or intermittent, steady or pulsatile, low or high pitch, and may range in intensity from very soft to severely loud. Unfortunately, there is no “magic bullet” or quick-fix for tinnitus, despite what many television advertisements may lead you to believe. This may include playing soft music, using a “white noise” machine or pillow speakers, a radio turned to static, or a fan running.
Treatment should be started as soon as possible, and has the most benefit if started within 1-2 weeks of symptom onset. The second phase (#3 and #4 in the picture) consists of the actual sensation of sound in the inner ear and transmission of that sensation to the brain. Specific frequencies (or pitches) of sound stimulate specific groups of hair cells, which is how we can discriminate between high-pitched and low-pitched sounds, hear and appreciate different notes in music, etc.
If you use your voice all day long, it is important to take breaks, even short ones, to rest your voice. If you feel like you need something to help with drainage or thick mucous, a mucolytic like guaifenesin is ok to take. A deviated septum may result from prior trauma to the nose, or it may be something that is present since childhood. In some cases, the turbinates can become perpetually enlarged, which causes bothersome obstruction. Of course, some of the conservative (nonmedical) treatments listed above may be continued indefinitely. Here in Colorado, with our low relative humidity, the nose can become quite dry, which makes the nasal lining fragile and prone to cracking open. One is the size of the eardrum compared to the size of the oval window (the interface through which sound is passed to the inner ear).
Anyone who depends on their voice for their livelihood is considered a professional voice user. A cool-mist humidifier beside your bed (not at the other end of the house) can help prevent your throat from drying out at night. Lots of other medications have drying side effects, including many blood pressure medicines, diuretics (water pills), and antidepressants. Using a microscope to visualize the eardrum, a tiny knife is used to make a small incision in the eardrum.
Of course, cancerous tumors should be removed, often with removal of areas of lymph nodes in the neck, depending on the type of tumor. When used in patients who first fail oral steroids, it has about a 20-30% chance of hearing improvement. Avoid having long conversations if there is lots of background noise, as this will force you to raise (and strain) your voice. Any fluid in the middle ear is suctioned out, and a small plastic tube is positioned into the hole in the eardrum. For certain malignancies, additional treatment with radiation therapy after surgery is recommended. The ossicles (malleus, incus, and stapes), are three tiny bones in the middle ear (a space of air under the eardrum), which are connected to one another by joints. When this is the case, nosebleeds can be a lot harder to stop, and some even require hospitalization.
People who take blood thinning medications, such as aspirin, Plavix, warfarin and others, tend to have more severe nosebleeds that are more difficult to stop.



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16.09.2015 admin



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